To the Editor.—Dr. Leonard Levy raises a good point in stating that redness and distortion of the light reflex alone may not be associated with bacterial infection of the middle ear. This has been shown by various investigators who studied the bacterial flora of otitis media and found that tympanic aspiration in patients presenting with redness of the drum alone remained usually sterile.
In all of our four treatment trials bulging was recorded at a very constant rate, namely in 54% to 56% of all cases and perforation in 14% to 21%. We also tested that these findings were equally distributed in the various treatment groups and I doubt that a true difference in treatment results would have been obscured by the remaining 25% to 30% of patients with redness and distortion of the light reflex alone.
Doctor Levy concedes that redness and distortion of the light reflex may